knee pain matthew a. close, do steadman-hawkins sports medicine greenville hospital system...
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Knee PainMatthew A. Close, DO
Steadman-Hawkins Sports MedicineGreenville Hospital System University Medical Center
Chief Complaint and HistoryCC:
16-year-old offensive lineman who presented to the training room with left knee pain after a football game
HPI:No specific injury during the gameSwelling and moderate pain afterwards No giving way, locking or catchingMild numbness over the top of his kneeNo previous injury
Physical Exam
Inspection: Moderate soft tissue edema antero-medially. Antalgic gait.
Palpation: Trace effusion, TTP at anterior medial joint line, and distal medial quadriceps with deep palpation.
ROM: Active 5/0/115, Passive produced pain with flexion past 120 degrees.
Physical Exam
Strength: 5/5 strength in knee flexion/extension.
Stability: Stable in varus/valgus at 0 and 30 degrees. Negative Lachman. Stable ant/post drawers.
Special Tests: Discomfort with McMurray, but no click.
Neurovascular: Numbness over top of knee. Pulses 2/4 at DP and PT.
Differential Diagnosis
Differential Diagnosis
ACL tear
Medial meniscal tear
Patella contusion
Partial quadriceps tear
Thigh contusion
Prepatellar bursitis
MCL sprain
Tests and Results
Tests and Results
5 Days Post-Injury
MRI
MRI Results
Extensive subcutaneous edema anteriorly with mild fluid collection between subQ fat and underlying fascia.
Increased signal in posterior medial meniscus, no tear.
Grade 1 chondromalacia of patella.
Cruciate and collateral ligaments without injury.
Final Working Diagnosis
Final Working Diagnosis
Historical Perspective
Maurice Morel-Lavallee (1853)
Tejwani SG, et al. Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the National Football League. Am J Sports Med. 2007; 35(7):1162-1167.24 patients (27 knees)
14 (52%) conservative 13 (48%) aspiration (mean 2.7 times)
3 (11%) doxycycline sclerodesis
Time to full resolution 16.3 days
Treatment and Outcome
TreatmentNeoprene compression sleeve, cryotherapy, rest. Rehabilitation coordinated with school’s athletic
trainer, emphasizing ROM exercises and quadriceps strengthening.
Swelling and ecchymosis eventually resolved.
OutcomePt returned to football practice after 2 weeks, and
resumed starting position 3 weeks after injury.
Prepatellar Bursitis